Laboratory Investigation of a Nosocomial Transmission of Tuberculosis at a District General Hospital

Huang, Wei‐Lun; Jou, Ruwen; Yeh, Pen-Fang; Huang, Angela

doi:10.1016/s0929-6646(07)60002-3

Cited by 7 publications

(4 citation statements)

References 25 publications

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“…The geospatial findings in the present study are consistent with molecular epidemiologic findings [5]–[9]. A large nosocomial TB outbreak in 2003 involving 66 health care workers at a district hospital in Taipei was traced to an index case who was hospitalized in February 2002 by matched DNA fingerprints [5].…”

Section: Discussionsupporting

confidence: 86%

“…A large nosocomial TB outbreak in 2003 involving 66 health care workers at a district hospital in Taipei was traced to an index case who was hospitalized in February 2002 by matched DNA fingerprints [5]. Mycobacterial interspersed repetitive-unit-variable-number tandem-repeat (MIRU-VNTR) typing and spoligotyping was performed on TB isolates from 365 patients treated at a hospital in Taipei from 2002–2004; these results showed that 236 (65%) were clustered by genotype [7].…”

Section: Discussionmentioning

confidence: 99%

“…Reactivation has been assumed to be the predominant mode of pathogenesis because of age transition in tuberculosis patients – from a disease of young adults during 1957–1961 to a disease of elderly (≥65 years) people during 1997–2001 [4]. Although several outbreaks of active TB cases, which occurred in a family or within a hospital, were identified using genotyping techniques [5]–[9], there remains a lack of nationwide genotyping or geospatial investigations on the role of recent transmission in the TB endemic in Taiwan.…”

Section: Introductionmentioning

confidence: 99%

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Spatial Dependency of Tuberculosis Incidence in Taiwan

Wen

Wang

et al. 2012

PLoS ONE

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Tuberculosis (TB) disease can be caused by either recent transmission from infectious patients or reactivation of remote latent infection. Spatial dependency (correlation between nearby geographic areas) in tuberculosis incidence is a signature for chains of recent transmission with geographic diffusion. To understand the contribution of recent transmission in the TB endemic in Taiwan, where reactivation has been assumed to be the predominant mode of pathogenesis, we used spatial regression analysis to examine whether there was spatial dependency between the TB incidence in each township and in its neighbors. A total of 90,661 TB cases from 349 townships in 2003–2008 were included in this analysis. After adjusting for the effects of confounding socioeconomic variables, including the percentages of aboriginals and average household income, the results show that the spatial lag parameter remains positively significant (0.43, p<0.001), which indicates that the TB incidences of neighboring townships had an effect on the TB incidence in each township. Townships with substantial spatial spillover effects were mainly located in the northern, western and eastern parts of Taiwan. Spatial dependency implies that recent transmission plays a significant role in the pathogenesis of TB in Taiwan. Therefore, in addition to the current focus on improving the cure rate under directly observed therapy programs, more resource need to be allocated to active case finding in order to break the chain of transmission.

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Section: Discussionsupporting

confidence: 86%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Spatial Dependency of Tuberculosis Incidence in Taiwan

Wen

Wang

et al. 2012

PLoS ONE

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“…Recent reports of nosocomial TB outbreaks in Taipei, caused by delays in diagnosis and treatment [ 8 , 9 ], suggest that institutionalized TB reporting and DOTS alone may be insufficient to achieve targets established by Stop TB. In particular, previous studies have shown that TB diagnosis can be very complicated in hospitals, and delayed diagnosis is most likely to occur for hospitalized patients [ 10 ].…”

Section: Introductionmentioning

confidence: 99%

"Cough officer screening" improves detection of pulmonary tuberculosis in hospital in-patients

et al. 2010

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BackgroundCurrent tuberculosis (TB) reporting protocols are insufficient to achieve the goals established by the Stop TB partnership. Some countries have recommended implementation of active case finding program. We assessed the effect of Cough Officer Screening (an active screening system) on the rate of TB detection and health care system delays over the course of four years.MethodsPatients who were hospitalized at the Changhua Christian Hospital (Changhua, Taiwan) were enrolled from September 2004 to July 2006 (Stage I) and August 2006 to August 2008 (Stage II). Stage II was implemented after a Plan-Do-Check-Act (PDCA) cycle analysis indicated that we should exclude ICU and paediatric patients.ResultsIn Stage I, our COS system alerted physicians to 19,836 patients, and 7,998 were examined. 184 of these 7,998 patients (2.3%) had TB. Among these 184 patients, 142 (77.2%) were examined for TB before COS alarming and 42 were diagnosed after COS alarming. In Stage II, a total of 11,323 patients were alerted by the COS system. Among them, 6,221 patients were examined by physicians, and 125 of these patients (2.0%) had TB. Among these 125 patients, 113 (90.4%) were examined for TB before COS alarming and 12 were diagnosed after COS alarming. The median time from COS alarm to clinical action was significantly less (p = 0.041) for Stage I (1 day; range: 0-16 days) than for Stage II (2 days; range: 0-10 days).ConclusionOur COS system improves detection of TB by reducing the delay from infection to diagnosis. Modifications of scope may be needed to improve cost-effectiveness.

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The Tuberculosis Outbreak Response, Investigation, and Control

Fontaine

2017

Handbook of Global Tuberculosis Control

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Laboratory Investigation of a Nosocomial Transmission of Tuberculosis at a District General Hospital

Abstract: Thorough collection along with molecular diagnosis and genotyping of all M. tuberculosis isolates are recommended for the confirmation of any suspected nosocomial TB outbreak.

Cited by 7 publications

References 25 publications

Spatial Dependency of Tuberculosis Incidence in Taiwan

Spatial Dependency of Tuberculosis Incidence in Taiwan

"Cough officer screening" improves detection of pulmonary tuberculosis in hospital in-patients

The Tuberculosis Outbreak Response, Investigation, and Control

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